Geriatric Assessment Predicts Overall Survival Among Older Adults Receiving Induction Chemotherapy for Acute Myelogenous Leukemia.

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 1535-1535 ◽  
Author(s):  
Heidi D. Klepin ◽  
Janet A. Tooze ◽  
Ann M. Geiger ◽  
Stephen Kritchevsky ◽  
Jeff Williamson ◽  
...  
Keyword(s):  
Older Adults ◽  
Overall Survival ◽  
Activities Of Daily Living ◽  
Grip Strength ◽  
Geriatric Assessment ◽  
Induction Therapy ◽  
Acute Myelogenous Leukemia ◽  
Daily Living ◽  
Myelogenous Leukemia ◽  
Acute Myelogenous

Abstract Abstract 1535 Background: Acute myelogenous leukemia (AML) is a disease which largely affects older adults, for whom optimal therapy is unclear. Evidence-based strategies to identify those older adults who may tolerate and benefit from standard therapies are lacking. Objective: Evaluate the predictive value of bedside geriatric assessment (GA) on overall survival (OS) for older adults receiving induction therapy for AML. Methods: Ongoing prospective study of patients ≥60 years of age with newly diagnosed AML and planned induction chemotherapy admitted to Wake Forest University. Bedside GA was performed during inpatient work-up for AML. GA measures included the Modified Mini-Mental Status Exam (3MS), Center for Epidemiologic Studies Depression Scale (CES-D), Distress thermometer, Pepper Assessment Tool for Disability ([PAT-D], includes self- reported activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility questions), Short Physical Performance Battery ([SPPB], includes timed 4-meter walk, chair stands, standing balance), and grip strength. Cox proportional hazards models were fit for each GA measure as a predictor of OS, controlling for age, gender, Eastern Cooperative Oncology Group (ECOG) score, Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI) score, and cytogenetic risk group. The median follow-up was 4.7 months. Results: Among 53 consecutive patients the mean age was 69 (SD 11.5) years, 59.3% were female, and 46.3% had significant comorbidity (HCT-CI score >1). The majority had intermediate (72.6%) or poor risk (23.6%) cytogenetics. Approximately two thirds (64.7%) received standard induction therapy with anthracycline, cytarabine ± etoposide. Mean baseline GA scores included: 3MS 82.4 (SD 9.6), CES-D 13.5 (SD 11.3), Distress 4.2 (SD 3.3), PAT-D 1.6 (SD 0.6), SPPB 6.4 (SD 4.2), grip strength 32.0 kilograms (SD 8.5). In adjusted analyses, better performance on the cognitive screen (3MS) was associated with improved OS (HR 0.94, 95% CI 0.89–0.99). There was a trend towards worse OS among individuals who screened positive for depression at baseline (CES-D>16) (HR 2.3, 95% CI 0.75–6.80) and among those with a slower gait speed (< 1 meter/second) (HR 5.9, 95% CI 0.80–45.3). Additional baseline GA measures were not associated with OS in this analysis. Conclusions: Geriatric assessment measures may independently predict OS among older adults receiving induction therapy for AML. If validated in future studies, these screening measures may improve risk stratification and inform interventions to improve outcomes for older adults with AML. Supported by the American Society of Hematology Scholar Award, Atlantic Philanthropies, the John A. Hartford Foundation, ASP, and the WFU Pepper Center (P30 AG-021332). Disclosures: No relevant conflicts of interest to declare.

Inpatient Geriatric Assessment Detects Impairment Among Older Adults Receiving Induction Chemotherapy for Acute Myelogenous Leukemia.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1401-1401
Author(s):  
Heidi D Klepin ◽  
Ann M Geiger ◽  
Jeff Williamson ◽  
Stephen Kritchevsky ◽  
Janet A Tooze ◽  
...  
Keyword(s):  
Older Adults ◽  
Activities Of Daily Living ◽  
Grip Strength ◽  
Induction Chemotherapy ◽  
Geriatric Assessment ◽  
Acute Myelogenous Leukemia ◽  
Daily Living ◽  
Myelogenous Leukemia ◽  
Performance Score ◽  
Acute Myelogenous

Abstract Abstract 1401 Poster Board I-423 Background: Acute myelogenous leukemia (AML) is a disease which largely affects older adults, for whom optimal therapy is unclear. Evidence-based strategies to identify those older adults who may tolerate and benefit from standard therapies are lacking. Objective: Test the utility of a bedside geriatric assessment (GA) to detect impairment in multiple geriatric domains among older adults initiating induction chemotherapy for AML. Methods: Ongoing prospective study of patients ≥60 years of age with newly diagnosed AML and planned induction chemotherapy admitted to Wake Forest University. Bedside geriatric assessment (GA) was performed during inpatient work-up for AML. GA measures included the Modified Mini-Mental Status Exam (3MS), Center for Epidemiologic Studies Depression Scale (CES-D), Distress thermometer, Hematopoietic Cell Transplantation Comorbidity Index (HCT-CI), Pepper Assessment Tool for Disability ([PAT-D], includes self- reported activities of daily living (ADL), instrumental activities of daily living (IADL), and mobility questions), Short Physical Performance Battery ([SPPB], includes timed 4-meter walk, chair stands, standing balance), and grip strength. Results: 26 of 29 eligible patients enrolled between 1/2009 and 8/2009. The median age was 68 (range 60-82) years, and 42.3% were female. Prior myelodysplastic syndrome was present in 34.6%, with intermediate or poor-risk cytogenetics in 95.6%. Baseline laboratory measures included white blood cell count (mean 17.3×103/mm3, SD 25.0×103), hemoglobin (mean 9.2g/dl, SD 1.5), lactate dehydrogenase (mean 282.4 U/L, SD 168.8). Mean baseline GA scores included: 3MS 83.0 (SD 14.7), CES-D 9.4 (SD 9.3), Distress 3.8 (SD 3.4), HCT-CI 1.3 (SD 1.6), PAT-D 1.4 (SD 0.7), SPPB 7.1 (SD 3.9), grip strength 32.4 kilograms (SD 9.2). Although 84.6% of subjects had an Eastern Cooperative Oncology Group (ECOG) Performance score <2, a substantial proportion met criteria for impairment in multiple geriatric domains. Conclusions: GA measures detect abnormalities which are not adequately reflected by the ECOG performance score in older adults with AML. Future analyses from this ongoing study will evaluate whether these abnormalities are independently associated with treatment-related morbidity and survival. Disclosures: No relevant conflicts of interest to declare.

Feasibility of Inpatient Geriatric Assessment for Older Adults with Newly Diagnosed Acute Myelogenous Leukemia

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 3996-3996
Author(s):  
Heidi D Klepin ◽  
Leslie Renee Ellis ◽  
Denise Levitan ◽  
Bayard Powell
Keyword(s):  
Older Adults ◽  
Grip Strength ◽  
Physical Performance ◽  
Geriatric Assessment ◽  
Acute Myelogenous Leukemia ◽  
Self Report ◽  
Myelogenous Leukemia ◽  
Newly Diagnosed ◽  
Wide Range ◽  
Acute Myelogenous

Abstract Background: Acute myelogenous leukemia (AML) is a disease which largely affects older adults, for whom optimal therapy is unclear. Evidence based strategies are lacking to identify those older adults who may tolerate and benefit from standard therapies. Objective: Test the feasibility of pre-treatment, inpatient geriatric assessment (GA) in older adults hospitalized with newly diagnosed AML. Methods: Prospective evaluation of consecutive patients ≥60 years of age with newly diagnosed AML and planned induction chemotherapy admitted to a single institution from 6/2007–6/2008. Bedside GA was performed within 72 hours of diagnosis. In addition to demographics and routine labs, the GA measures obtained by a trained nurse included Mini-Mental Status Exam (MMSE), Center for Epidemiologic Studies Depression Scale (CES-D), Charlson Comorbidity Index (CCI), Vulnerable Elders Survey-13 (VES-13), Short Physical Performance Battery (SPPB, includes timed 4 meter walk, chair stands, standing balance), and grip strength. Measures to assess feasibility included: recruitment; time to complete the assessment, and proportion completing entire GA battery. Results: Among 22 eligible inpatients, 11 enrolled (50%). The median age was 71 (range 63–78) and 72.7% were female. Poor risk cytogenetics were present in 27.3%. Laboratory measures included white blood cell count (mean=24.6×103/mm3, SD 26.2×103), hemoglobin (mean=8.5 g/dl, SD 1.6), platelet count (mean=60.3×103/mm3, SD=38.4×103), lactate dehydrogenase (LDH) (mean=340.0 U/L, SD=235.1), and albumin (mean=3.2 g/dl, SD=0.36). 66.6% of participants completed the entire GA battery; the remainder completed only self-report measures. Mean time for completion of the GA was 36.8 minutes (SD 9.8). Mean scores for survey measures included: MMSE=26.1 (range 21–30, SD 3.2), CCI=1.6 (range 0–4, SD 1.1), CES-D=22.9 (range 8–37, SD 11.0), VES-13 survey=5.0 (range 1–8, SD 2.5). A wide range of objective physical performance was demonstrated including mean SPPB total score=7.4 (range 5–10; SD 2.1), mean timed 4 meter walk=12.9 seconds (range 6.6–22.1; SD 5.1), and mean grip strength=29.3 (range 12–62; SD 16.8). Conclusions: Inpatient GA including physical performance assessment is feasible in older adults hospitalized for AML and our preliminary findings demonstrate significant variability in cognitive, emotional and physical status. These measures may represent valuable candidate predictors of outcomes, and ongoing studies will identify which measures are most predictive of treatment morbidity and response.

scholarly journals Geriatric assessment predicts survival for older adults receiving induction chemotherapy for acute myelogenous leukemia

Blood ◽  
2013 ◽  
Vol 121 (21) ◽  
pp. 4287-4294 ◽  
Author(s):  
Heidi D. Klepin ◽  
Ann M. Geiger ◽  
Janet A. Tooze ◽  
Stephen B. Kritchevsky ◽  
Jeff D. Williamson ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Function ◽  
Induction Chemotherapy ◽  
Geriatric Assessment ◽  
Acute Myelogenous Leukemia ◽  
Trial Design ◽  
Myelogenous Leukemia ◽  
Key Points ◽  
Prediction Of Survival ◽  
Acute Myelogenous

Key Points Geriatric assessment, with a focus on cognitive and physical function, improves prediction of survival among older adults treated for AML. Use of geriatric assessment may inform trial design and interventions to improve outcomes for older adults with AML.

Stem Cell Transplant Versus Chemotherapy in Older Adults with Acute Myelogenous Leukemia In First Remission

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 2146-2146
Author(s):  
Ellin Berman ◽  
Molly Maloy ◽  
Sean M. Devlin ◽  
Esperanza B Papadopoulos ◽  
Ann A. Jakubowski
Keyword(s):  
Older Adults ◽  
Overall Survival ◽  
Stem Cell ◽  
Cord Blood ◽  
Induction Chemotherapy ◽  
Acute Myelogenous Leukemia ◽  
Stem Cell Transplant ◽  
Myelogenous Leukemia ◽  
Cell Transplant ◽  
Acute Myelogenous

Abstract Introduction Optimal therapy for older adults with acute myelogenous leukemia (AML) who achieve remission following induction chemotherapy has not been determined. Options include consolidation chemotherapy (CC) or stem cell transplant (SCT) if an appropriate donor is identified. In order to determine whether SCT improved overall survival (OS) or whether associated toxicity was increased, we performed a retrospective study comparing SCT with CC in this older age group. Methods All adult patients ages 60 to 75 years with AML in 1st remission (CR1) who underwent a SCT at MSKCC between 2001 and 2013 were reviewed and compared to age-matched patients with AML who achieved CR1 and received CC. A landmark analysis at 3 months following CR1 was used to compare OS for the 2 patient groups. Only SCT patients transplanted by landmark time were included in the analysis. Overall survival was compared using Kaplan-Meier methodology. Results Sixty-eight patients were identified for the SCT group. Thirty-two patients were identified for the CC group (Table). Stem cell sources included: peripheral blood (n=63), cord blood (n=4) and bone marrow (n=1). Fifty-six patients received a T cell depleted transplant (32 with ClinMACsTM and 24 with IsolexTM ) and 12 received an unmodified product. Conditioning regimens were busulfan/melphalan/ fludarabine (n=54), melphalan/fludarabine (n=4), cyclophosphamide/fludarabine/thiotepa/ TBI (n=4), fludarabine/busulfan (n=3), busulfan/melphalan (n=2) and thiotepa/fludarabine/TBI (n=1). Donors included matched unrelated (n=28), matched related (n=25), mismatched unrelated (n=11) and mismatched cord blood (n=4). For patients in the CC group, induction chemotherapy included cytarabine in combination with either idarubicin (n=21), daunorubicin (n=10), or mitoxantrone plus etoposide (n=1). Forty-four patients received their transplant by the 3 month landmark and 30 patients in the CC group were alive at the landmark and were included in the OS analysis. Deaths in the SCT group included 4 patients from infection, 1 from treatment-related toxicity, and 1 from relapsed disease. The estimated OS at 2 years in the landmark groups were 64% in the SCT group and 42% in the CC group (p=0.04). Conclusions Recognizing the inherent bias when retrospective studies compare SCT and CC, these data support the use of SCT for older patients with AML in CR1 who have an appropriate donor. Despite the older age, there was a statistically significant better OS with low 100 day mortality for those patients who underwent SCT. Disclosures: No relevant conflicts of interest to declare.

scholarly journals The Feasibility of Inpatient Geriatric Assessment for Older Adults Receiving Induction Chemotherapy for Acute Myelogenous Leukemia

2011 ◽  
Vol 59 (10) ◽  
pp. 1837-1846 ◽  
Author(s):  
Heidi D. Klepin ◽  
Ann M. Geiger ◽  
Janet A. Tooze ◽  
Stephen B. Kritchevsky ◽  
Jeff D. Williamson ◽  
...  
Keyword(s):  
Older Adults ◽  
Induction Chemotherapy ◽  
Geriatric Assessment ◽  
Acute Myelogenous Leukemia ◽  
Myelogenous Leukemia ◽  
Acute Myelogenous

scholarly journals Analyzing How Elderly Acute Myeloid Leukemia Patients Are Treated, an Institutional Experience

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5849-5849
Author(s):  
Christopher Allen Willner ◽  
Mohammad Muhsin Chisti ◽  
Michaela Soriano ◽  
James Huang
Keyword(s):  
Overall Survival ◽  
Acute Myeloid Leukemia ◽  
Data Analysis ◽  
Induction Therapy ◽  
Acute Myelogenous Leukemia ◽  
Myeloid Leukemia ◽  
Myelogenous Leukemia ◽  
Elderly Populations ◽  
Acute Myelogenous ◽  
Acute Myeloid

Rationale: Treatment of acute myelogenous leukemia (AML) remains a challenge in elderly populations, those with comorbid conditions, and patients with poor performance status indices. The optimal choice for induction therapy as well as further agent selection is unclear, and current guidelines recommend enrollment in a controlled clinical trial. Methods: Institutional cases of AML via an electronic medical record query performed in November 2017 containing cases of AML in patients 65 years of age or greater from 01/01/2000 to 06/21/2017 were extracted. Instances of acute myelogenous leukemia were identified by ICD codes. Age, gender, induction therapy, cytogenetics, molecular analyses, and overall survival were collected. Results: A total of 61 cases of AML in patients aged 65 or greater were identified, with those having incomplete data being excluded from analysis. The mean age of included patients was 78.9 years of age, 35 were male and 26 were female. 60 confirmed deaths were recorded. 26 patients received conventional 7+3 (42.6%), 22 received a hypomethylating agent (HMA) (31.1%), 16 (26.2%) did not receive treatment. Conclusion: Our institutional data showed overall survival was significantly longer when treated with 7+3, 354 days (95% CI [93, 614]), vs. 61 days (95% CI [15, 107]). Similarly, OS was significantly longer when treated with HMA, 303 days (95% CI [23, 583]). Risk of death, accordingly, was as follows: 7+3 HR .347 (.179-.672), HMA HR .348 (.173-.703). Our institutional mortality data reasonably reflected SEER data analysis reported by Medeiros et al concerning untreated patients, but trended toward a greater OS for those treated with 7+3 or HMA. Registry data, as well as our institutional data, demonstrate a survival benefit to intensive chemotherapy and palliative chemotherapy, while controlled trials have not shown this benefit consistently in elderly populations. Practices regarding induction therapy vary greatly between institutions. Determination of which elderly patients to treat with intensive therapy remains difficult. References: Almeida AM, Ramos F. Acute myeloid leukemia in the older adults. Leuk Res Rep. 2016;6:1-7. Eleni LD, Nicholas ZC, Alexandros S. Challenges in treating older patients with acute myeloid leukemia. J Oncol. 2010;2010:943823. Medeiros BC, Satram-hoang S, Hurst D, Hoang KQ, Momin F, Reyes C. Big data analysis of treatment patterns and outcomes among elderly acute myeloid leukemia patients in the United States. Ann Hematol. 2015;94(7):1127-38. Disclosures Chisti: Eli Lilly: Speakers Bureau; Medscape: Honoraria; UpToDate: Honoraria.

Improved survival for patients with acute myelogenous leukemia.

1995 ◽  
Vol 13 (3) ◽  
pp. 560-569 ◽  
Author(s):  
A J Mitus ◽  
K B Miller ◽  
D P Schenkein ◽  
H F Ryan ◽  
S K Parsons ◽  
...  
Keyword(s):  
Overall Survival ◽  
Acute Myelogenous Leukemia ◽  
Myelogenous Leukemia ◽  
Remission Induction ◽  
Term Survival ◽  
Free Survival ◽  
Significant Difference ◽  
Acute Myelogenous ◽  
To Receive

PURPOSE Despite improvement in chemotherapy and supportive care over the past two decades, overall survival for patients with acute myelogenous leukemia (AML) remains poor; only 25% to 30% of individuals with this disorder will be cured. In 1987, we initiated a prospective multiinstitution study designed to improve long-term survival in adults with AML. METHODS We modified the usual 7-day treatment scheme of daunorubicin and cytarabine with high-dose cytarabine (HiDAC) on days 8 through 10 (3 + 7 + 3). Allogeneic or autologous bone marrow transplantation (BMT) was offered to all patients who entered complete remission (CR) to decrease the rate of leukemic relapse. Data were analyzed by intention to treat. RESULTS CRs were achieved in 84 of 94 patients (89%; 95% confidence interval [CI], 83 to 95). Because of the high remission rate, factors previously thought to predict outcome, such as cytogenetics, WBC count, French-American-British (FAB) classification, sex, and age, were not useful prognostic variables. The overall survival rate for the entire cohort of patients from data of diagnosis is 55% at 5 years. Sixty percent of all patients who achieved a CR underwent marrow grafting. There was no significant difference in event-free survival (EFS) at 5 years comparing patients assigned to receive allogeneic BMT with patients assigned to receive autologous BMT (56% v 45%, P = .54). CONCLUSION The long-term disease-free survival observed in this study is excellent compared with historical data. This improvement in survival is probably due to the high rate of remission induction, as well as to the effective nature of the consolidation therapy.

Sign in / Sign up

Export Citation Format

Share Document